This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, August 09, 2014

Weekly Overseas Health IT Links - 9th August, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Culprits Include Hackers, Insider Threats, Staff Errors and More

The federal tally of major health data breaches has grown substantially in recent weeks to a total of 1,074 incidents affecting 33.7 million individuals since September 2009. The approximately 30 incidents added to the list over the last month provide examples of the variety of risks that healthcare entities continue to battle.

Among the largest breaches added to the tally in recent weeks were a hacking incident, an insider breach and a mismailing of letters. Still, the loss or theft of unencrypted computing devices remains the most common cause of breaches affecting 500 or more individuals.

The Centers for Medicare and Medicaid Services (CMS) has issued its final rule officially setting the ICD-10 transition date for October 1, 2015. Asserting that the new date “allows ample time” for the healthcare industry to prepare for the change, the final rule confirms what the agency told the industry in May after the one-year delay was voted through as part of the Protecting Access to Medicare Act of 2014.

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of CMS in a press release announcing the finalization. “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

Hospitals cannot assume they're safe from hackers, writes Daniel J. Nigrin, M.D., in a perspective on healthcare cybersecurity at The New England Journal of Medicine.

Nigrin (pictured), senior vice president for information services and CIO at Children's Hospital Boston, writes about lessons learned from an attack in April believed to be the work of the hacker group Anonymous. There is no direct evidence implicating the group in the attack, though it took up the cause of a teen girl placed in state custody.

"As healthcare organizations push forward to further enable electronic health records ... the potential effect of losing Internet connectivity is large, and the analysis required to understand that effect is complex," Nigrin writes.

Infection surveillance systems, lab outreach services and patient acuity applications are poised for growth in the U.S. hospital IT market, according to new research from HIMSS Analytics.

The three applications have the “most attractive” opportunities because the market for them is not saturated and sales volumes are projected to grow, said Lorren Pettit, vice president of market research at HIMSS Analytics. The growth projections are in the recently released summer 2014 edition of the HIMSS Analytics Essentials of the U.S. Hospital IT Market report.

“As the healthcare IT industry shifts its focus to technology that empowers clinical efficacy and preventative care, it is not surprising that first-time sales outlook for these three applications is so positive,” said Pettit. “The findings suggest that opportunities for lab and nursing application vendors are ripe in this maturing market.”

National Coordinator for Health IT Karen DeSalvo, displeased with the Boston Globe's recent article portraying electronic health records as error-prone and lacking safety oversight, responded by pointing out what she called flaws in the newspaper's reporting.

In an editorial published July 27 in the Globe, DeSalvo relayed that she was "disappointed" that the article provided no examples of the many success stories about EHRs and patient safety and that their omission from the article "incompletely portrays the important role of electronic health records in improving patient safety and outcomes."

Kaiser Permanente and Johns Hopkins Medicine have announced plans to strengthen their collaboration by focusing on research and evidence-based care, according to an announcement.

The two plan to share patient data from electronic medical records and develop better models for delivering care.

"This is a commitment for these two organizations to work on tangible projects related to quality, affordability and service," Kim Horn, president of Kaiser Foundation Health Plan of the Mid-Atlantic States, told the Washington Business Journal.

Three of the most persistent and pernicious untruths about ICD-10 are tackled by AHIMA as confusion clouds the lead up to a long-overdue switchover.

In the August issue of the Journal of AHIMA, Sue Bowman, senior director of coding policy and compliance at AHIMA, takes aim at some lingering misconceptions about ICD-10 as coders and IT workers, perhaps skeptical of the coming changes, move -- sometimes haltingly -- toward the October 2015 compliance date.

"The transition to ICD-10 continues to be inevitable and time sensitive," said AHIMA CEO Lynne Thomas Gordon, in a press statement. "As the healthcare industry experiences an additional delay in ICD-10 implementation, now is the ideal time to rebut ICD-10 myths that continue to percolate."

Successful 21st century healthcare organizations do not thrive based on the intuition of a few brilliant leaders; rather, they become modern data-driven businesses. Delivering better care, fostering population health and greatly reducing the per capita cost of care does not happen without targeted investments in big data analytics.

In my experience with healthcare analytics, I’ve observed several best practices in the big data space that have consistently boosted return on analytics investment for both health plans and health systems. Each one of these imperatives acts as a multiplier for big data analytics investments, which can shape business fitness – and patient health – for years to come.

It's official. The Government Accountability Office today affirmed what the general public knew this past October: the launch of the HealthCare.gov website was a poorly-planned and mismanaged disaster -- one that cost the federal government a pretty penny.

Leading up to the October go-live of the ill-fated federal health insurance website, the Centers for Medicare & Medicaid Services, the agency responsible for overseeing the site, failed to implement effective oversight practices and forged ahead with development despite not knowing "key technical requirements," wrote William T. Woods, director of acquisition & sourcing management at GAO, in a July 31 testimony.

Telemedicine, much to the delight of some health industry observers, is a prominent part of legislation announced this week allocating $16.3 billion to overhaul the U.S. Department of Veterans Affairs.

The proposed bill, which sailed through the House on a 420-5 vote on Wednesday, requires that all VA mobile vet centers and mobile medical centers have the capability to provide telemedicine services. The bill also requires an annual report be sent to Congress outlining the use of telemedicine by such centers.

Two of the most well-known healthcare organizations in the country--Kaiser Permanente and Johns Hopkins Medicine--announced a collaborative this week that will allow the two to, among other things, share best practices on electronic medical record (EMR) usage.

At the center of the collaboration, the organizations say, is an attempt to leverage the strengths of two established organizations and advance the healthcare system toward evidenced-based medicine and advanced population health. The two plan on collaborating on education and research initiatives. One specific goal is to advance clinical information access for patients and providers as well as personalized medicine through IT.

Medical privacy and security concerns involving electronic health records are prevalent among patients. The majority of patients — 83 percent — expect hospitals to use electronic health records, but only 53 percent said they trust the safety and security of EHRs, according to a poll by Morning Consult.

Corporate wellness programs have been of growing interest to employers for years. Today, more than 90% of employers with 200 or more workers have some type of health promotion or disease-prevention program in place, according to the U.S. Department of Labor.

Capital One, the Federal Reserve, Google, New York City and the U.S. Army all have at least one thing in common: they each employ a chief data officer to oversee their big data programs.

The emergence of the Chief Data Officer closely mirrors a trend we saw in the 1980s when companies began to adopt personal computers, servers and digital technology en masse. At the time, some organizations realized that such a massive initiative required a combination of expertise and executive-level leadership. As a result, the chief information officer was born, and, by the 1990s, the CIO was ubiquitous on executive teams.

We believe that CDOs will become universal as well. Companies in retail, manufacturing, agriculture, resource extraction, finance and professional services and tech, among others, will soon realize that big data is too specialized and too much of a responsibility for the CIO or CTO. As we will illustrate, big data initiatives are high value but also high risk endeavors. A data scientist with executive powers is critical to making sure data science delivers.

In many ways, mobile device security is an oxymoron in its current state. In fact, if you're using an Internet of Things-type device, chances are it has an average of 25 hidden vulnerabilities, according to new research, making it a ripe target for hackers.

That's according to a new HP-led study that sheds light on the alarming number of connected devices with serious security weak spots. As the data reveals, a whopping 70 percent of all commonly used mobile devices and apps have these vulnerabilities.

In the study, HP researchers scanned 10 of the most common IoT devices, identifying 250 total security concerns. And although the devices tested included products from TV, webcam, remote power outlets and home alarm manufacturers, unprotected health data contained on apps was a concern.

The Department of Health has reportedly lost its long-standing court battle with Fujitsu over the company’s departure from the National Programme for IT.

A legal dispute between the DH and the company has been ongoing since 2008, when Fujitsu’s £896m contract for the South of England was terminated.

The company was supposed to install Cerner Millennium at trusts across the South, but left the programme with just nine ‘live sites’ in place. At one of its inquiries into NPfIT last year, the Commons’ health select committee was told that it was seeking £700m. At the same hearing, it was reported that the legal costs in the case had reached £31.5m.

Draft legislation in the House Energy and Commerce Committee would require the Department of Health and Human Services to publish recommendations for development of clinical data registries to improve patient care.

The bill, introduced by Rep. Pete Olson (R-Tex.), calls for specific recommendations from the HHS Secretary “for a set of standards that, if adopted, would allow for the bidirectional, interoperable exchange of information between the electronic health records of the reporting clinicians and such registries.” The proposed legislation directs HHS to come up with recommendations on how clinical registries, including outcomes-based registries, may be developed and used to evaluate the impact of care models and methods on the management of chronic diseases based on clinical practice guidelines and best practices--such as A1C, blood pressure, and cholesterol levels in the case of diabetes.

Until healthcare providers recognize and address their security weaknesses, they risk data loss, vulnerability to hacking, and HIPAA non-compliance. While some hospitals are expending the appropriate resources, experts say too many have yet to fully embrace the philosophy and culture of security necessary to protect patients, employees, and partners. Currently about 52% of healthcare organizations have a full-time resource for security, according to the 6th Annual HIMSS Security Survey. In terms of investment, 30% spent 1% to 3% of their budgets on IT security; 19% spent less than 1%, and another 19% spent between 4% and 6% of IT budget, the report found.

For at least the last decade, the health IT field has seen a scholarly back-and-forth on the effectiveness of electronic medical records. As soon as one study is published that finds technology has little impact on patient outcomes, another emerges that seems to show just the opposite.

These studies are frequently limited by the size of the data set or scope of the analysis. Take, for example, a June 2014 JAMA article that found meaningful users of electronic health records failed to deliver improved care for five chronic diseases. According to one news report, the new study cast “doubt on whether the tens of billions of dollars invested to encourage EHR adoption among healthcare providers is really enhancing patient outcomes.”

The analysis, it turns out, included just three months of data from 818 physicians (about .1 percent of the 834,769 active physicians practicing in the United States) across seven clinical quality measures. By the way, all those physicians were employed by a single hospital or its affiliated practices.

Not all medical infrastructure and equipment is created equal, as healthcare providers can attest. This year, after analyzing feedback from thousands of providers, KLAS officials have named the 2014 highest performing vendors across 23 different categories.

The 2014 Best in KLAS: Medical Equipment and Infrastructure report highlights vendor solutions that ultimately excel in their category against their competitors' products, officials say.

The top performers this year were Omnicell, which walked away with five awards, and Philips, which earned four. Many of this year's top performers continued winning streaks from last year.

Electronic health records have a big role to play in improving hospitals' medication reconciliation, a new study finds, but challenges related to data quality, technology and workflow remain.

Medication reconciliation is a systematic way to reduce medical errors by ensuring accurate patient medication lists at admission, during a hospitalization and at discharge. Unintended discrepancies are common, with some research finding they affect as many as 70 percent of hospital patients at admission or discharge – with almost one-third of those potentially causing harm.

Still, despite hospital accreditation and other requirements, use of med rec technology has lagged for many reasons – including insufficient physician engagement, which stems, in part, from lack of professional consensus about which physician is responsible for managing a patient's medication list, according to the new report from National Institute for Health Care Reform.

A GP who received one of the requests is concerned that the companies may be breaching the principles of the Data Protection Act.

Dr Paul Cundy, who is joint chairman of the British Medical Association and Royal College of GPs’ joint IT committee, contacted EHI after receiving a subject access request from Aviva for the full medical records of one of his patients for a life insurance policy.

BOSTON—Health apps still have a long way to go before achieving goals of wellness and facilitating healthcare delivery. Issues surrounding usability, trust and convenience remain hurdles, according to speakers at the mHealth + Telehealth World 2014 on July 23.

Big data is revolutionizing healthcare, said Jared Reitzen, CEO and owner of mobileStorm and owner of mHealth watch, predicting that gamification will help motivate healthy behaviors in consumers given that it is personalized and engaging.

However, at the present time, poor design of apps is a “really big problem.” Healthcare needs to strive for simplicity in a way that Apple did under Steve Jobs, he said. “We need to bring healthcare closer to Silicon Valley.”

Following the implementation of electronic health records in a clinic, otolaryngology residents had to reallocate time directly caring for patients to update the EHRs, according to a study in Laryngoscope.

Researchers conducted a time-motion study observing the time residents spent on typical clinic activities during both operative days and clinic days.

At the July 10 Health IT Policy Committee meeting, CMS and the Office of the National Coordinator for Health IT reported the latest Stage 2 attestation numbers: 972 eligible professionals (EPs) and 10 eligible hospitals (EHs) through July 1.

Nearly the entire industry is amazed by the paltry attestation volume so far. However, the Stage 2 bar is very challenging to reach, and from our previous research, we anticipated such a dramatically slow attestation trend. Last year, we conducted interviews with more than 100 hospitals in integrated delivery networks across the country to assess their levels of Stage 2 readiness. We evaluated interviewee responses on a four-point scale and converted the values to percentages, with 100% being "Process not yet evaluated for Stage 2," and 0% being "No gaps remaining to remediate." The top-two Stage 2 core objectives for which hospitals were least prepared one year ago was Transition of Care (TOC) and View, Download and Transmit (VDT) (see Figure 1).

Once again, Google has captured the news cycle with the announcement of an ambitious, health-focused project. But although Google’s health portfolio continues to grow, its handful of health projects are still little more than pet projects to the search giant.

As reported last week by The Wall Street Journal, the Google Baseline study will use a combination of genetic testing and digital health sensors to collect “baseline” data on healthy people. The idea is to establish genetic biomarkers relating to “how [patients] metabolize food, nutrients and drugs, how fast their hearts beat under stress and how chemical reactions change the behavior of their genes.”

The study, which is starting with 175 patients at an undisclosed clinic, is in some ways a novel approach to healthcare. It takes full advantage of some relatively recent developments: the current low price of sequencing a genome and the capacity of digital health sensors to collect 24/7 real-world health data. Because of these two advancements, Google is able to create a healthcare study focused solely on well patients, which could produce data on the nuances of the human body’s normal functionality that doctors have never had before.

Scott Mace, for HealthLeaders Media , July 29, 2014

When it comes time for healthcare providers to get paid, forget complex algorithms and cutting edge reporting systems. It's the lowly JPEG—yes, the common PC image file format—that's bringing home the bacon.

So much of the sizzle of healthcare information technology seems like a tour of the bridge of the starship Enterprise, or perhaps a quick sprint through Starfleet engineering.

For at least the last decade, the health IT field has seen a scholarly back-and-forth on the effectiveness of electronic medical records. As soon as one study is published that finds technology has little impact on patient outcomes, another emerges that seems to show just the opposite.

These studies are frequently limited by the size of the data set or scope of the analysis. Take, for example, a June 2014 JAMA article that found meaningful users of electronic health records failed to deliver improved care for five chronic diseases. According to one news report, the new study cast “doubt on whether the tens of billions of dollars invested to encourage EHR adoption among healthcare providers is really enhancing patient outcomes.”

The analysis, it turns out, included just three months of data from 818 physicians (about .1 percent of the 834,769 active physicians practicing in the United States) across seven clinical quality measures. By the way, all those physicians were employed by a single hospital or its affiliated practices.

The Senate Appropriations Committee has directed the ONC's Health IT Policy Committee to submit a report on the technical, operational and financial barriers to information-sharing among electronic health records systems--what it calls the "information-blocking problem"--and what should be done to combat it.

"ONC should use its authority to certify only those products that ... do not block health information exchange," the budget report states. "ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in [certified EHR technology], and make [the technology] less valuable and more burdensome for eligible hospitals and eligible providers to use."